Antibiotics for most sinus infections are anti-effective

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Sinus infections are miserable. Anyone suffering from one wants relief as soon as possible. The tricky thing is, the overwhelming majority of such infections are caused by viruses; only about 2 percent of sinus infections are bacterial. Since viral infections do not respond to antibiotics, having your doctor prescribe an antibiotic is unlikely to help. And a new study just published in the Journal of the American Medical Association confirms this: Sinus infection patients treated with the antibiotic amoxicillin were no better off than those given a placebo pill.

A sinus infection, also called acute sinusitis, typically involves severe pain around the eyes, nose, and forehead, a fever, and a runny or stuffed nose. Because doctors can t readily discern between a viral and a bacterial sinus infection, and patients are often adamant about being treated aggressively, antibiotics are often unnecessarily prescribed. This is a problem, not least because it can lead to the emergence of drug-resistant bacteria which could eventually make actual bacterial infections much more difficult to treat.

In this study, led by a doctor at the Washington University School of Medicine, researchers used official U.S. guidelines to diagnose patients with sinus infections. They then randomly assigned 166 adults to either a course of placebo pills or a 10-day treatment with amoxicillin. Patients rated their symptoms on an accepted scale of measurement and, after 10 days, there was no significant difference between the two groups: 78 percent of the patients on amoxicillin and 80 percent of those taking the placebo said they felt a lot better or that they no longer had symptoms. Clearly, notes Dr. Kava, these patients must have been suffering from self-limiting conditions or else the placebos would not have been as effective as the antibiotic.

A committee at the Infectious Diseases Society has recently developed guidelines to help distinguish bacterial from viral sinus infections. These guidelines advise antibiotics only for patients whose symptoms have not improved after ten days, or for those who are severely ill with a high fever and other distinct symptoms.

Both ACSH s Dr. Elizabeth Whelan and Dr. Gilbert Ross agree that sinus infections are one of the most common examples of the over-prescription of antibiotics. However, Dr. Ross observes that it s difficult to make a patient wait 10 days before trying a course of antibiotics. It s more reasonable, he advises, to prescribe them pain killers as needed, and to recommend sinus drainage with steam inhalation, asking them to communicate or come back in several days if they don t see improvement. The average patient will not be willing to endure a sinus infection for ten days without seeking more aggressive treatment.